Policy explained · Star Health
Star Health Assure: what your policy covers
Star Health Assure caps room rent at 1% of the sum insured a day on a ₹5 lakh cover. It has a 10% co-pay if you joined at 61 or older, and it covers consumables. On a typical ₹4,50,000 knee & hip replacement bill, the insurer pays about ₹3,51,000 to ₹3,60,000 and you pay about ₹90,000 to ₹99,000 (estimate).
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At a glance
- 🛏️1% of SI a dayRoom rent1% of the sum insured a day (sum insured 5 to 7.5 lakh)Policy wordings, page 9, read 28 Sep 2026
- 🧾10%Co-payIf you joined at 61 or olderNot in the worked examplePolicy wordings, page 20, read 28 Sep 2026
- ⏳24 monthsKnee & hip replacement waitOver by month 30Conditions apply, see the termsPolicy wordings, page 28, read 28 Sep 2026
- ⏳36 monthsPre-existing conditions waitNot over at month 30Conditions apply, see the termsPolicy wordings, page 27, read 28 Sep 2026
- 🩹CoveredConsumablesConditions apply, see the termsPolicy wordings, page 20, read 28 Sep 2026
Waiting periods, month by month
- Pre-existing conditions36 monthsNot over at month 30Conditions apply, see the terms
- Knee & hip replacement24 monthsOver by month 30Conditions apply, see the terms
- Spine surgery24 monthsOver by month 30Conditions apply, see the terms
- Prostate surgery24 monthsOver by month 30Conditions apply, see the terms
- Hysterectomy24 monthsOver by month 30Conditions apply, see the terms
Worked example: a knee & hip replacement bill
The example person joined the policy before age 61, is treated at a network hospital in the zone their policy covers, has no add-ons, and has a ₹5,00,000 sum insured on a policy running 30 months.
Room rent ₹9,000 a day for 4 days (example), a semi-private room, on a typical NCR knee & hip replacement bill of ₹4,50,000 (estimate).
Not in these numbers: a 10% co-pay applies if you joined at 61 or older.
₹90,000 Room above the room rent limit: room, doctor and OT charges cut in the same ratio (estimate)
₹0 to ₹9,000 could go either way: non-payable items, 0% to 2% of the bill because consumables are covered (estimate)
| Step | Amount (estimate) |
|---|---|
| Bill total | ₹4,50,000 |
| Room above the room rent limit: room, doctor and OT charges cut in the same ratio | minus ₹90,000 |
| Insurer's share before non-payable items and co-pay | ₹3,60,000 |
| Non-payable items, 0% to 2% of the bill because consumables are covered | minus ₹0 to ₹9,000 |
| Insurer pays | ₹3,51,000 to ₹3,60,000 |
| You pay | ₹90,000 to ₹99,000 |
The terms, with the policy text
12 terms read from the Star Health Assure documents (UIN SHAHLIP26048V032526). Open a source to read the policy text, its conditions and the page.
| Term | What it means | Policy text and source |
|---|---|---|
| Room rent limit | 1% of the sum insured a day (sum insured 5 to 7.5 lakh)Limit applies | Policy wordings, page 9Sum Insured in lakhs (Rs.) 5/7.5 10/15/20/25 50/75/100 / 200 Room Rent Criteria Up to 1% of Sum Insured per day Any Room (Except suite or above category) Any room |
| ICU limit | Paid at actual costNo limit | Policy wordings, page 46Condition: The same on every sum insured. ICU/Operation Theatre Charges Actuals |
| Co-pay | 10% of the claim is yours if you joined at 61 or olderOnly in some cases | Policy wordings, page 2029. Co-payment: This policy is subject to co-payment of 10% of each and every claim amount for fresh as well as renewal policies for Insured Person whose age at the time of entry is 61 years and above. |
| Proportionate deduction | Applies: if your room costs more than the limit, the insurer cuts the charges linked to the room in the same ratioCan cut your bill | Policy wordings, pages 9 to 10Condition: Applies to nursing, OT and doctors' fees, not to pharmacy, consumables, implants, diagnostics or ICU charges, and not at hospitals that charge the same for every room. Note: Associated Medical expenses which vary based on the room occupied by the Insured Person will be considered in proportion to the room rent stated in the policy schedule or actuals whichever is less. |
| Consumables (gloves, masks and other non-medical items) | Covered (Covered) | Policy wordings, page 20Condition: Built into the policy: the non-medical items in List I (gloves, masks and the like) are paid when the hospital claim is admissible. 27. Coverage for Non-medical Items (Consumables): If there is an admissible claim under inpatient / day care of the policy, then Items as per List I will become payable. |
| Costs before and after the hospital stay | 60 days before admission, 180 days after dischargeCovered | Policy wordings, page 105. Pre-Hospitalization Expenses: Medical expenses incurred up to 60 days immediately before the Insured Person is hospitalized. 6. Post-Hospitalization Expenses: Medical expenses incurred up to 180 days immediately after the Insured Person is discharged from the hospital. |
| Waiting period for pre-existing conditions | 36 months of continuous coverNot over at month 30 | Policy wordings, page 27Condition: On a 3-year policy term the wait is 30 months instead of 36. Applicable for 1 year and 2 year Policy Term: Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with insurer |
| Waiting period for knee & hip replacement | 24 months of continuous coverOver by month 30 | Policy wordings, page 28Condition: Not applicable to claims arising from an accident. 3. All treatments (Conservative, Operative treatment) and all types of intervention for Diseases related to Tendon, Ligament, Fascia, Bones and Joint Including Arthroscopy and Arthroplasty / Joint Replacement [other than caused by accident]. |
| Waiting period for spine surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 28Condition: Not applicable to claims arising from an accident. 4. All types of treatment for Degenerative disc and Vertebral diseases including Replacement of bones and joints and Degenerative diseases of the Musculo-skeletal system, Prolapse of Intervertebral Disc (other than caused by accident), |
| Waiting period for prostate surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 28Condition: Not applicable to claims arising from an accident. 9. All Diseases of Prostate, Stricture Urethra, all Obstructive Uropathies, |
| Waiting period for hysterectomy | 24 months of continuous coverOver by month 30 | Policy wordings, page 28Condition: Not applicable to claims arising from an accident. 8. All treatments (conservative, interventional, laparoscopic and open) related to all Diseases of Cervix, Uterus, Fallopian tubes, Ovaries, Uterine Bleeding, Pelvic Inflammatory Diseases |
| Exclusion rule for bariatric surgery | Covered when the policy's conditions are metConditions apply | Policy wordings, page 30Condition: Covered when it is medically needed: on a doctor's advice, for someone 18 or older with a BMI of 40 or more, or 35 or more with a serious related illness. 6. Obesity/ Weight Control - Code Excl 06: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions; |
Questions
Does Star Health Assure have a room rent limit?
At a ₹5 lakh sum insured: 1% of the sum insured a day. This 1% limit is for a ₹5 lakh or ₹7.5 lakh sum insured. From ₹10 lakh to ₹25 lakh: any room except a suite or above. From ₹50 lakh: any room. Source: Policy wordings, page 9, read 28 Sep 2026.
How is proportionate deduction calculated on Star Health Assure?
If your room costs more than the room rent limit, the insurer divides the limit by your room's daily rent and pays that share of the charges linked to the room. Applies to nursing, OT and doctors' fees, not to pharmacy, consumables, implants, diagnostics or ICU charges, and not at hospitals that charge the same for every room. In the worked example on this page, a ₹9,000 a day room cuts ₹90,000 from room, doctor and OT charges (estimate). Source: Policy wordings, page 9, read 28 Sep 2026.
Check your own policy
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Sources
- Star Health Assure: policy wordings (accessed 28 Sep 2026)
- Star Health Assure: customer information sheet (cis) (accessed 28 Sep 2026)